Medicare Covers COVID-19 Tests & CMS Issues Guidance to Medicare Advantage & Part D Plans

Medicare Covers COVID-19 Tests & CMS Issues Guidance to Medicare Advantage & Part D Plans

As the coronavirus is spreading nationally and globally, the Centers for Medicare and Medicaid Services (CMS) announced early in March that Medicare will cover coronavirus testing. All COVID-19 tests ordered by your doctor or other health care provider will be covered under Medicare Part B as a diagnostic laboratory test, and therefore has no out-of-pocket costs. Coverage can be back dated to February 4, 2020, and providers must wait until April 1, 2020 to submit their bills to Medicare.

 

Guidance to Medicare Advantage & Part D Plans

Medicare coverage of COVID-19 testing is one of many federal agencies’ response to this outbreak. CMS sent guidance to all Medicare Advantage and Part D plans regarding required actions and flexibilities to increase access to treatment and prescriptions. Some of these “flexibilities” include allowing access to out-of-network providers, providing additional prescription refills, waiving prior authorizations and/or cost-sharing, and offering telehealth options. The guidance also reviews their obligations of coverage when a state has formally declared an emergency.

 

Guidance to Nursing Homes & Other Facilities/Agencies

CMS also issued revised guidance on March 9th to all nursing home facilities to help curb the spread of COVID-19, as older adults and communities of older residents are at greater risk for more serious complications from the virus. The guidance includes information on how to screen and limit visitors, how to monitor and restrict staff who develop symptoms, and what considerations and guidance to take into account when transferring a resident with suspected or confirmed COVID-19 to a hospital or receiving such a patient from a hospital. In addition, CMS has sent guidance to dialysis facilities, home health agencies, hospice agencies and more. See CMS’ current emergencies page for all updates and guidance on the Coronavirus.

 

New FAQs on Essential Health Benefits to be covered in response to COVID-19

CMS has a new Frequently Asked Questions (FAQs) document on Essential Health Benefits (EHB) Coverage in response to the COVID-19 outbreak as well. This is to help ensure all Americans, insurers and states have clear information on their coverage benefits for COVID-19.

 

Congressional Legislation

On Wednesday 3/11, the House of Representatives introduced Families First Coronavirus Response Act (H.R. 6201), which would address some of the most immediate needs in our country. This includes paid leave for direct services providers and family caregivers, free COVID-19 testing, expansion of unemployment insurance, expanded nutrition assistance through SNAP and programs for older adults, people with disabilities, and Native Americans, and more federal funding for state Medicaid programs. This bill has still to go to the Senate.

 

In early March, Congress and the President signed an $8.3 billion emergency spending package to respond to COVID-19, including funding for testing kits, developing and distributing vaccines, buying medical supplies and funding for states to use in their COVID-19 responses.

 

Resources from the Administration for Community Living

The Administration for Community Living has a webpage with continual Centers for Disease Control (CDC) updates called What do Older Adults and People with Disabilities Need to Know about COVID-19? It outlines many practical tips on how to protect oneself and prevent the spread of COVID-19 and also has information in Spanish.

Karen Fletcher
Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.